The following investigations are not routinely recommended for the specialist assessment of bothersome LUTS by NICE (CG97).
A. Flow rateAnswer E
The NICE LUTS guidance 2010 recommends that in the specialist assessment of a patient with LUTS, the clinician should offer: An assessment of general medical history to identify possible causes and co-morbidities, including a review of all current medication (including herbal and over-the-counter medication) that may be contributing to the problem A physical examination guided by symptoms and other medical conditions, an examination of the abdomen and external genitalia, and a DRE (Jones et al., 2010).
Further tests include a flow rate and post-void residual volume measurement as well as a urinary frequency volume chart. Men should be offered information, advice and time to decide if they wish to have PSA testing if; their LUTS are suggestive of benign prostatic enlargement or the prostate gland feels abnormal or they are concerned about prostate cancer.
The guidance only recommends a cystoscopy and/or imaging of the upper urinary tract when there is a history of recurrent infection, sterile pyuria, haematuria, pain or chronic retention.